called it a "Quiz" Compend, he would have described it exactly, for such it is and nothing more. To aid the student in preparing for his examination it will answer admirably. We do not believe the general practitioner will find it of value. To write a "Manual of the Diseases of Women" would seem to require more experience in and attention to the subject treated of than, as a rule, a gentleman just graduated from a medical service in a general hospital, and now devoting his attention to a widely remote specialty, can be presumed to have. We find absolutely no fault with the book. It is a clear and concise statement of diagnostic and therapeutic points culled, as Dr. May tells us in his preface, from the writings of Emmet, Thomas, Mundé, Simpson, etc. As such we commend it, and, within the limits stated, believe it will prove useful to the student. When he begins to practise, however, he must considerably reinforce the knowledge thus acquired by the study of systematic treatises on gynecology. EGBERT H. GRANDIN. THE MANAGEMENT OF LABOR AND OF THE LYING-IN PERIOD. By "The aim of the book is to serve as a guide to practice, divested of all superfluous or irrelevant details." The author has accomplished his aim, and the general practitioner will find within these pages, in concise statement, the leading and essential points in regard to the management of labor and of the puerperal period. Dr. Landis' teaching is eminently sound, usually abreast of the times, and yet tempered by sufficient conservatism. Under the subject of the treatment of placenta previa, we regret to find no reference to the method (Braxton-Hicks') recently advocated by Lomer and others, and we believe that in the treatment of puerperal eclampsia the use of morphia hypodermically has greater weight of authority than Landis grants. We notice, also, on page 41, that, where during labor the anterior lip of the cervix becomes impacted between the head and the pelvis, the advice is given to push it up during a pain. This is probably a lapsus, but needs correction, for there is no more certain way of lacerating the cervix. The anterior lip should be pushed over the head between the pains, and held there by the finger till the recurrence of the next pain. Beyond these few criticisms, we have simply good wishes for this little manual, and we believe it will meet with the full measure of success it deserves. EGBERT H. GRANDIN. THE BRITISH GYNECOLOGICAL JOURNAL, being the Journal of the DR. ALEXANDER criticises rather severely Dr. Munde's recent conclusions, published in the New England Medical Monthly, May, 1885, concerning the difficulties of the operation, saying that if Dr. Imlach (who states that in thirty-six cases he never failed to find the ligaments, and that a half-inch incision is enough) minimized matters to an extent that was unsafe for the inexperienced to follow, Dr. Mundé's conclusions erred far more in exaggerating the difficulties and uncertainties of the operation. Dr. Alexander should not have judged others by his own results, or think that no one should find difficulties in what he considers easy. The true status of the matter is probably in the middle ground between Dr. Mundé and Dr. Alexander, for while the latter, the father of the operation, naturally is inclined to exaggerate both the ease with which it can be accomplished and the benefits resulting from it, the cases of Dr. Mundé were undoubtedly exceptionally difficult. The following also shows that, though perhaps rare, cases do occur where the ligaments cannot be found. In several instances where I have performed the operation on the cadaver, the ligaments have been easily found and drawn out, except in one, the last subject, who was old and exceedingly fat. In this case, when I had cut down on the right side, I could not find any trace of the ligament on careful search, and on dissection from within outwards, the ligament was found to practically disappear in the inguinal canal, as only a few fibres could be traced through the external ring. The same conditions existed on the other side. The difficulty of the dissection was much increased by the quantity of fat present. I am convinced that in a similar case Dr. Alexander himself would have failed in performing his operation. Dr. Alexander then goes on to give a careful description of the minutiae of the procedure and of the after-treatment and results. The operation seems to be a very certain remedy for retro-displacements, and to be nearly as reliable in prolapsus, in this latter condition it having failed in only one of sixteen cases to effect a cure, and to relieve the symptoms due to these conditions in a large proportion of cases. That this is also Dr. Mundé's opinion is shown by three of his six cases, the first and fifth one being a retroflexion, the other a descensus, which were completely and permanently relieved by the operation. Thus, where the ligaments can be found and drawn out, a successful result may be expected. The mortality of the operation Dr. Alexander considers as nil, though he mentions three cases, one in his own practice, where death occurred, he considering that all three were due to entirely preventable causes. Dr. Lawson Tait mentioned a fourth case where death had occurred as a consequence of the operation, and a case which had occurred in his own hospital, where there were at the time fifteen or twenty cases of abdominal section with none of whom he had any trouble, in which the patient nearly died, being nine weeks in getting well, the temperature going up to 40° C. (104° F.) and pulse to 140. This showing would seem to prove that the mortality is certainly not nil, and that there is enough risk in the operation to prevent its performance except where palliative measures have failed, for we certainly are not entitled to submit a patient to possible serious danger except for the relief of serious symptoms. DR. JAMISON, of Shanghai, details a very interesting case of successful secondary perineorrhaphy where there was laceration through the upper edge of the sphincter ani. The recto-vaginal septum being split for an inch, and lateral flaps of mucous membrane raised in the vagina, the raw surfaces were united, tension being relieved by sliding the skin of the ischio-rectal space inwards, as in plastic operations on the face. The operation, though not at all clearly described, appears to be a good one in certain cases where there is a lack of available tissue to work upon. The flap operations for uniting perineal lacerations were strongly advocated in the discussion which followed the reading of the paper, the advantages being that less time was required in their performance and that a more substantial perineum was formed; the method being essentially that a flap is taken from each labium, one hinging in, and one outward, a strip being also thrown outward from the recto-vaginal septum. The in flap is first stitched to the opposite denuded wall, then the outer likewise to its opposite, and lastly the strip below is stitched to the cut edges of the lateral flaps. The arrangement of the journal continues the same as noted in the review of the first numbers. BROOKS H. WELLS. THE PATHOLOGY, DIAGNOSIS, AND TREATMENT OF THE DISEASES OF WOMEN. BY GRAILY HEWITT, M.D. LOND., F.R.C.P., Professor of Midwifery and Diseases of Women, University College, and Obstetric Physician to the Hospital, etc. A new American from the fourth revised and enlarged London edition. 236 Illustrations. Edited with notes and additions by HARRY MARION-SIMS, M.D., Attending Surgeon to St. Elizabeth's Hospital, New York, etc. Two volumes. New York: Bermingham & Co., 1885. Dr. Graily Hewitt's work and his peculiar views are so well known to the profession that it is unnecessary to enter upon a detailed review: The popularity of this book is sufficiently attested by the fact that it has passed through four editions, and whilst we cannot pretend to say that we accept the author's views in their entirety, we believe that they have had a very considerable effect in shaping, for good, the belief and practice of a large proportion of practitioners. In the present edition there is no essential change in Dr. Hewitt's teaching, but he has, to use his own prefatory words, "advanced a step further, and have explained, to my own satisfaction at all events, how and why it is that changes in the shape and position of the uterus are so liable to occur; what, in short, are their predisposing causes." The important factor in producing the above changes is lack of systemic strength, due to "a systematic, and often a lengthened, practice of taking little food." In short, the principle Hewitt endeavors to inculcate in this work is the dependence of local ailments on general ones-a principle but rarely taken into account as much as it should be, and attention to which will frequently render unnecessary zealous local treatment. The author has further devoted considerable space in these volumes to the subjects of hysteria and hystero-epilepsy, and has introduced a number of cases in support of his opinion that the nausea and vomiting of pregnancy are dependent on some cause which interferes with due expansion of the cervix-usually flexion. We notice, with pleasure, as coming from a transatlantic writer, the statement that trachelorrhaphy is a most necessary and valuable operation, although the description of the operation is utterly inadequate. The additions by the American editor are, in the main, judicious. We would express our surprise, however, that such an atrocious woodcut as the one on page 17, representing the duckbill speculum in position, should have been countenanced by a Sims. As an instance of hasty revision, we would call attention to pages 74 and 96, where the same note occurs almost word for word. The illustrations in this edition are frequently drawn lifesize, and whilst many of them are rather coarse, in general the book presented in a creditable form. EGBERT H. GRANDIN. THE TRANSACTIONS OF THE EDINBURGH OBSTETRICAL SOCIETY. Vol. X., Session 1884-85. Edinburgh: Oliver & Boyd, 1885, pp. 237. In one of several well-written papers by DR. FREELAND BARBOUR, he notes four cases, one in his own practice, the others collated, where albuminuria in pregnancy, with well-marked symptoms, had disappeared on the death of the fetus, the mother's health improving markedly. Could a sufficient number of like cases be observed, to show that the occurrence of diminution or stoppage of the albuminuria with death of the fetus in utero is more than a mere coincidence, it would tend to prove that in some instances albuminuria is due to a condition of the maternal blood induced by pregnancy, and would militate against the theory that it is caused by the pressure of the uterus on the ureters, or by change in the vascular tension of the kidneys, the mechanical conditions remaining the same after as before the death of the fetus. I am aware of no other cases besides those reported in Dr. B.'s paper where this same condition has been noted. The subject is worthy of investigation, the extreme paucity of its literature pointing to its rarity or to the fact that cases have not been considered of enough interest to report. DR. VASSILY SUTUGIN, in a communication treating of the prevention of lying-in fever, speaks very exhaustively of the antiseptic measures he considers necessary in the treatment of puerperal cases, they agreeing in all important details with those now used in the best lying-in hospitals. In speaking of the very slight danger of producing unpleasant symptoms by the free use of the bichloride of mercury solution (1-1,000), he seems to have overlooked the fact that a number of instances are on record of serious and even fatal poisoning from its use, and that where there is a suspicion of renal disease, it should always be used cautiously. We must also take exception to his statement that it is better to leave a portion of the membranes in the uterus, to be expelled later by natural processes, than to risk the introduction of the hand into the uterine cavity, which latter procedure, we believe, when done with proper precautions, to be productive of no harm to the patient that can be compared to that which is likely to occur from the presence of the retained membranes. Continuous pressure over the lower abdomen, which he applies by sandbags, has also been demonstrated by practical experience to be a superfluous procedure, and in many instances even an injurious one, increasing or producing a tendency to backward displacement of the uterus which is apt to become persistent. MR. SKENE KEITH, as no proper description is given in any work on diseases of women (sic), tells us of the correct way to hold Sims' speculum. We respectfully refer Mr. Keith, for further information, to Mundé's "Minor Surgical Gynecology" (1st ed., 1880, pp. 75 seq., and 2d ed., 1885, pp. 85 seq.), where precisely the same directions are given and illustrated by diagrams. DR. JAMES CARMICHAEL, in a well-digested paper on "Infant Feeding," starting from the physiological standpoint that mother's milk is the best food for the child, comes to the conclusion, which most of our authorities have already stated, that absolutely fresh cow's milk, suitably treated by the addition of water, sugar, and cream, so as most nearly to resemble human milk, is the best artificial food, and much better for the child than any of the other "infant foods." In the discussion of the paper which follows, regularity of feed ing and scrupulous cleanliness of the feeding apparatus is most strongly insisted upon, the old-fashioned, boat-shaped bottle being preferred, as more easy to keep clean, and as insuring the attention of the nurse during feeding. DR. JAMES RITCHIE gives the results of some experiments on milk curd, the milk, after admixture with various substances, being heated to 98, a little common salt and essence of rennet added, and the whole stirred and left in a water-bath at 98° for half an hour. Pure milk showed a very hard curd in large masses; dilution with water caused the curd to be considerably softer, that diluted with an equal part.giving a softer curd than where only one-third was added; acidulation of the milk and water with 0.02 per cent of dilute hydrochloric acid caused the curd to be much harder. Oatmeal, barley, or rice-water, in the proportion of onethird, caused the curd to be in small, soft flakes, and when acidulated, the curd was but very slightly harder. Boiled milk gave a curd in extremely small, soft flakes, but when acidulated, much firmer than in acidulated specimens having gruel added. One-third lime-water caused the curd to be in small, soft flakes, but when this mixture was rendered faintly acid, the curd was very hard. The curd of human milk was very soft and in small flakes. These experiments confirmed the measure of advantage found in practice by diluting the milk, the great benefit of boiling it, and the marked improvement in quality of the curd if it be kept open by mechanical means, as by the addition of gruels or limewater. They also show that this benefit is lost, in the case of the lime-water mixtures, if much acid is present, and that under such conditions a softer curd is obtained by mixture with gruels than by boiling only, or by addition of lime-water only. There are several other interesting papers in the volume, which, though very readable, is hardly up to its usual high standard. BROOKS H. WELLS. ABSTRACTS. 1. Winter: A Contribution to the Subject of Premature Detachment of the Placenta in Case of Nephritis (Ztschrft. f. Geb. und Gyn., XI., 2).—The mortality from premature separation of the placenta is 50% for the mother, and in the neighborhood of 95% for the fetus. The etiological factors of this accident are in doubt, and three cases which W. has recently seen tend to throw additional light on the subject. All the mothers recovered, but each fetus was lost, owing to the almost total separation of the placenta. A common factor in these three cases was the existence of a nephritis, and W. suggests that not impossibly premature separation of the placenta may depend on nephritis. From an analysis of one hundred and sixty cases, W. finds that in the majority the etiology is in doubt, whilst in others increase of abdominal pressure, such as results from cough, vomiting, or straining at stool, is stated as the cause. He finds but one case where nephritis was a complication. The hemorrhagic diathesis is a frequent accompaniment of nephritis, and as a result of this diathesis extravasation occurs under the placenta, leading to its separation. The management of these three cases was expectant, instead of following the rule to deliver quickly, and rely on uterine contractions to check the hemorrhage, and therefore W.'s three cases resulted in maternal recovery. He counsels, hence, retention of the membranes as |